Form D

[See rule 12(3)]

Form of application for cancellation or variation of nomination
This form shall be filled in by the holder(s) and submitted with the Certificates to the Post Master/Bank
Officer of the office where the (Certificates stand registers)
To
The Post Master/Branch Manager,

I/We..the
holder(s)of Kisan Vikas detailed hereby cancel the nomination previously made by in respect of these
Corticated
and
registered
in
your
office
under
No
.Date.
*In place of the cancelled nomination. I/We hereby nominate the person/s mentioned below. Who shall on
my/our death. Become entitled to the savings Certificates and be paid the sum due thereof to the exclusion
of all other persons.
SI. No.

Name of the nominee(s)

Full address

Date of birth of nominee in

case of minor

*To be filled in case of variation only

2. As the nominee (s) at the serial number(s).above is/are minor(s), I/We
appoint
Shri/Smt/Kumari..
(name and full address) as the person to receive the sum due thereon in the event of my/our death during
the minority of the nominee(s).
3. The Certificates detailed below enclosed.
SI. No. of Certificates
Denomination

Address:-

Date of issue

Office of issue

Yours Faithfully

..

Signature or Thumb impression

Witnesses:
1. NameAddress
2. NameAddress..
Note: In the case of illiterate holders. The witnesses shall be persons signatures are known to the Post
Office/Bank.

Order of the Post Master/Bank Officer accepting the nomination.

Date stamp of Office/
Bank Seal

Signature of Post Master/Bank Officer